Alzheimer's Disease is a progressive, neurodegenerative disorder characterized by memory impairment and cognitive dysfunction. AD is characterized pathologically by the accumulation of senile (neuritic) plaques, neurofibrillary tangles, amyloid deposition in neural tissues and vessels, synaptic loss, and neuronal death. It is the most common form of dementia and it now represents the third leading cause of death after cardiovascular disorders and cancer. The cost of Alzheimer's Disease is enormous (in the U.S., greater than $100 billion annually) and includes the suffering of the patients, the suffering of families, and the lost productivity of patients and caregivers. As the longevity of society increases, the occurrence of AD will markedly increase. It is estimated that more than 10 million Americans will suffer from AD by the year 2020, if methods for prevention and treatment are not found. Currently, AD is estimated to afflict 10% of the population over age 65 and up to 50% of those over the age of 85. No treatment that effectively prevents AD or reverses the clinical symptoms and underlying pathophysiology is currently available (for review see Selkoe, D. J. Ann. Rev. Cell Biol. 1994, 10, 373-403).
Histopathological examination of brain tissue derived upon autopsy or from neurosurgical specimens in affected individuals reveals the occurrence of amyloid plaques and neurofibrillar tangles in the cerebral cortex of such patients. Similar alterations are observed in patients with Trisomy 21 (Down's syndrome). Biochemical and immunological studies reveal that the dominant proteinaceous component of the amyloid plaque is an approximately 4.2 kilodalton (kD) protein of about 39 to 43 amino acids. This protein is designated Aβ, β-amyloid peptide, and sometimes β/A4; referred to herein as Aβ. In addition to its deposition in amyloid plaques, Aβ is also found in the walls of meningeal and parenchymal arterioles, small arteries, capillaries, and sometimes, venules. Compelling evidence accumulated during the last decade reveals that Aβ is an internal polypeptide derived from a type 1 integral membrane protein, termed β-amyloid precursor protein (APP) (Selkoe, D. Physiol. Rev. 2001, 81, 741-766; Wolfe, M. J. Med. Chem. 2001, 44, 2039-2060). βAPP is normally produced by many cells both in vivo and in cultured cells, derived from various animals and humans. Several proteolytic fragments of APP are generated by proteinases referred to as secretases. A subset of these proteolytic fragments, designated β-amyloid peptide (Aβ), contains 39 to 43 amino acids and is generated by the combined action of β-secretase and γ-secretase. β-secretase is a membrane-bound, aspartyl protease that forms the N-terminus of the Aβ peptide. The C-terminus of the Aβ peptide is formed by γ-secretase, an apparently oligomeric complex that includes presenilin-1 and/or presenilin-2. Presenilin-1 and presenilin-2 are polytopic membrane-spanning proteins that may contain the catalytic components of γ-secretase (Seiffert, D.; Bradley, J. et al., J. Biol. Chem. 2000, 275, 34086-34091).
In addition to AD, excess production and/or reduced clearance of Aβ causes cerebral amyloid angiopathy (CAA) (reviewed in Thal, D., Gherbremedhin, E. et al., J. Neuropath. Exp. Neuro. 2002, 61, 282-293). In these patients, vascular amyloid deposits cause degeneration of vessel walls and aneurysms that may be responsible for 10-15% hemorrhagic strokes in elderly patients. As in AD, mutations in the gene encoding Aβ lead to an early onset form of CAA, referred to as cerebral hemorrhage with amyloidosis of the Dutch type, and mice expressing this mutant protein develop CAA that is similar to patients.
A logical approach to reducing Aβ levels is to interfere with the action of the secretases that are directly involved in the cleavage of APP to Aβ. The β-secretase enzyme (BACE) is responsible for cleaving APP and forms the amino-terminus of Aβ, initiating the amyloidogenic pathway. The BACE enzyme is a transmembrane aspartyl protease and was described in the literature by several independent groups [see Hussain, I. et al., Mol. Cell. Neurosci., 1999, 14, 419-427; Lin, X. et al., Proceedings of the National Academy of Sciences of the United States of America 2000, 97: 1456-1460; Sinha, S., et al., Nature 1999, 402, 537-540; Vassar, R., et al., Science 1999, 286, 735-741; Walsh, D. M., et al., Biochemical Transactions 2002, 30, 552-557; Wolfe, M. J. Med. Chem. 2001, 44, 2039-2060; Yan, R. et al., Nature 1999, 402, 533-537].
Removal of BACE activity in mice by gene targeting completely abolishes Aβ production [see Luo, Y., et al., Nature Neuroscience 2001, 4, 231-232; Roberds, S. L., et al., Human Molecular Genetics 2001, 10, 1317-1324]. BACE −/− mice also show no detectable negative phenotypes, suggesting that disruption of BACE-mediated cleavage of APP does not produce additional undesired effects. This demonstrates that a drug substance capable of inhibiting β-secretase activity should lower or halt the synthesis of Aβ and should provide a safe treatment for Alzheimer's disease.
PCT Publication WO 2005049585, published Jun. 2, 2005 discloses novel macrocyclic lactams for the treatment of neurological and vascular disorders related to β-amyloid generation and/or aggregation.
PCT Publication WO 2005018545 A2, published Mar. 3, 2005 discloses macrocyclic BACE inhibitors for the treatment of Alzheimers.
Published article Ghosh, A. K. et al., Bioorganic and Medicinal Chem. Lett. 2005, 15, 15-20 discloses macrocyclic amide-urethane inhibitors of BACE.
PCT Publication WO 2004062625 A2, published Jul. 29, 2004 discloses macrocyclic BACE inhibitors for the treatment of Alzheimers.
PCT Publication WO 2002100856 A1, published Dec. 19, 2002 discloses macrocycles useful in the treatment of Alzheimers.
PCT Publication WO 2004013098, published Feb. 12, 2004, discloses lactam derivatives as beta-secretase inhibitors.
PCT Publication WO 2003072535, published Sep. 4, 2003, discloses substituted hydroxyethylamines in the treatment of Alzheimer's Disease.
At present there remains an urgent need to develop pharmaceutical agents capable for effective treatment in halting, slowing, preventing, and/or reversing the progression of Alzheimer's disease. Compounds that are effective inhibitors of beta-secretase, that inhibit beta-secretase mediated cleavage of APP, that are effective inhibitors of Aβ protein production by beta-secretase, and/or are effective in reducing soluble Aβ protein, amyloid beta deposits or amyloid beta plaques, are needed for effective treatment in halting, slowing, preventing, and/or reversing neurological disorders related to Aβ protein production, such as Alzheimer's disease.